NPIMap

Organization Active NPI

Peebles Family Care Home

Doing business as PALS Assisted Living Services Inc

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Stockton, CA
National Provider Identifier
1578749149
Registry record updated Jan 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
Legal business name
PEEBLES FAMILY CARE HOME
Doing business as
PALS Assisted Living Services Inc
Practice address
404 North Broadway Ave
Stockton, CA 95205
Phone
(209) 464-3024
Fax
(209) 944-5659
NPI assigned
Jan 14, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Nawana Miesa Gray
Title
Administrator Ceo
Phone
(209) 298-0849

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X CA Primary

Addresses

Primary practice location

404 North Broadway Ave
Stockton, CA 95205

Mailing address

404 North Broadway Ave
Stockton, CA 95205
Phone (209) 464-3024

Other names 1

  • PALS Assisted Living Services Inc Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Peebles Family Care Home4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1200268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200268800000",
    "number": "1578749149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 NORTH BROADWAY AVE",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "95205",
            "telephone_number": "209-464-3024",
            "fax_number": "209-944-5659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 NORTH BROADWAY AVE",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "95205",
            "telephone_number": "209-464-3024",
            "fax_number": "209-944-5659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEEBLES FAMILY CARE HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-14",
        "last_updated": "2008-01-14",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "NAWANA",
        "authorized_official_middle_name": "MIESA",
        "authorized_official_title_or_position": "ADMINISTRATOR CEO",
        "authorized_official_telephone_number": "209-298-0849",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PALS Assisted Living Services Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stockton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.